过敏性鼻炎的诊断和治疗学习资料课件

NasalmucosalhyperreactiverhinopathyAllergicRhinitis(AR)Perennial~(PAR),Seasonal~(SAR)（Pollinosis）Morbidity:10%~20%Inhalantallergens——dustmite,housedust,pollen,fungi,animaldanders,cockroach；Foodallergens——milk,eggs,fishandshrimp,meat,vegetables,fruits.

MiteMoldPollenCatAntigensforallergicrhinitis变应性鼻炎的病因学

内在因素──遗传因素：有家族史者较无家族史者发病危险高２～６倍母系第１１对染色体长臂ｑ段外在因素（环境因素）：基因表达受非遗传因素影响。７０００对孪生儿，同时有AR症状者为２１％易感个体在一定环境条件作用下才发病变应原与致敏靶细胞表面IgE结合致敏靶细胞脱粒、释放、合成生物活性介质肥大细胞储备的介质新合成的介质组胺缓激肽白三烯血小板活化因子前列腺素D2毛细血管扩张、通透性增加，腺体分泌增多

嗜酸/碱性粒细胞哮喘鼻炎发病机制Pathology：Typeallergy

Allergicinflammation:PredominantTcells&eosinophiliccellsinfiltrate.Symptoms&Signs：Nasalirritationandichingrecurrentattacksofparoxysmalsneezingcopiouswateryrhinorrheanasalobstruction鼻后滴漏Diagnosis：1、History（allergenexposure,hypersensitivity,familyhistory）2、Examination3、Skintest:skinpricktest4、IgEantibody，SerumtotalIgE、specialIgE5、NasalprovocationornasalchanllengetestsDifferentialDiagnosis：1、Vastomotorrhinitis2、Nonallergicrhinitiswitheosinophiliasyndrome,NARES3、Hyperreflectoryrhinitis4、AcuterhinitisComplications：1、Allergicsinusitis2、Asthma3、Secretoryotitismedia4、AllergicpharyngolaryngitisTreatment：1、Avoidance2、Drugs1）Antihistamines2）Corticosteroids3）Sodiumcromoglycate(SCG)Cromolynsodium4）Anticholinergicagents5）Vasoconstrictorsympasthomimetics3、Hyposensitization4、Others：TraditionalChinesemedicine,laser,operationNasalPolyp&NasalPolyposisEtiology：mutilfactors1.allergic；2.chronicinflammationPathology：highlyswelledconnectivetissue.Predominanteosinophiliccellsinfiltrate.Lymphaticcells,neutrophils,basophils,mastcells.Polypinmaxillarysinus（L），polypinmiddlemeatus（R）Symptoms&Sign：persistentnasalobstruction，closenasalsound，hyposmia,rhinorrhea,snore,“frognose”AntrochoanalpolypAntrochoanalpolypDiagnosis：Anteriorrhinoscopy：translucent,soft,smoothmasses.Endoscopy,X-rayandCTscanner.DifferentialDiagnosis：Papillomainverted，angiofibromaofnasopharynx，malignanttumorofnasalcavity，meningoencephaloceleTreatment：1、conservativetreatment——corticosteroids2、surgicaltreatmentPolyps（above），papilloma（below）papilloma（L），MTofnasalcavity（R）SinusitisAcutesuppurativesinusitisFeaturesofsinusanatomy：1、smallostiaofthesinuses；2、continuativemucosabetweennasalcavityandsinuses；3、contiguousoftheostia；4、locationoftheastiaandfeaturesofthesinuses.FrontalSinus

EthmoidSinusMaxillarySinusEtiology：1、Generalfactors:Poorgeneralhealth(influenza,measles,whoopingcough…)2、Localfactors：Sinusdiseases；Infectivefocusoferipheralorgans，Directinfection；Nasaltampon(packing)；Rapidchangeofatmosphericpressure

ABS主要病原体：肺炎链球菌和嗜血流感杆菌SAHP.OtolaryngolHeadNeckSurg.2004;130:1-45.20-43%22-35%Anaerobes0-9%Staphylococcusaureus

0-8%Otherbacteria4%MoraxellacatarrhalisOtherstreptococci3-9%2-10%S.pneumoniae成人Acutebacterialrhinosinusitis(ABS)病因H.influenzae儿童Acutebacterialrhinosinusitis(ABS)病因ABS主要病原体：肺炎链球菌、嗜血流感杆菌和卡他莫拉菌OtolaryngolHeadNeckSurg.2004;130:1-45.Symptoms&Signs：Generalsymptoms：Malaise,fever.Localsymptoms:1）Nasalobstructionsustained,withhyposmia2）Suppurativerhinorrhea,streakywithblood,foulsmell(odontogentic~)3）headachorlocalacheAntralpain——frominnercanthusdownwardsacrossthecheek,upperalveolusontheaffectedside.Ethmoidalpain——overbridgeofthenose&innercanthusbehindtheeye.Frontalpain——forehead,periodicity,persistforanhourortowaftergettingupinthemorning,andclearduringtheafternoon.Sphenoidalpain——occipitalorverticalheadache.Diagnosis：History，Signs,Anteriorrhinoscopy,Nasalendoscopy,Radiologicalexamination,PunctureandirrigationofmaxillarysinusTreatment：Eradicatecauses，keepdrainage；controlinfectionandpreventcomplications1、Generaltreatment：takerest，antibiotics，antihistamine(ifnecessary)2、Localtreatment3、Bodydrainage4、Physicaltherapy5、

PunctureandirrigationofmaxillarysinusMaxillarysinuspunctureandirragationChronicsuppurativesinusitisEtiology：Acute——ChronicSymptoms&Signs：General~:Local~：rhinorrhea,nasalobstruction,headache,hyposmia,visiondisorderDiagnosis：1、History；2、Examination：anteriorrhinoscopy,nasalendoscopy3、Radiologicalexamination：CTorMRI4、PunctureandirrigationofsinusNormalimageofnasalendoscopyMaxillarysinusitis——pusinthemiddlemeatusMaxillarysinusitis(R)Sphenoidsinusitis——pusinthesphenoethmoidalrecessSphenoidsinusitisPansinusitisPansinusitisTreatment：1、Intranasalmedications：Corticosteroid，Vasoconstrictorsympasthomimetics2、Punctureandirrigationofmaxillarysinus3、Displacementmethod——frontalsinusitis,ethmoidalsinusitis,sph